Heather H Keller1, Renata Valaitis2, Celia V Laur3, Tara McNicholl2, Yingying Xu2, Joel A Dubin2, Lori Curtis2, Suzanne Obiorah4, Sumantra Ray5, Paule Bernier6, Leah Gramlich7, Marilee Stickles-White8, Manon Laporte9, Jack Bell10. 1. University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada; Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Canada. Electronic address: hkeller@uwaterloo.ca. 2. University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada. 3. University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada; NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cowley Road, Cambridge CB4 0WS, UK. 4. The Ottawa Hospital, L'Hôpital d'Ottawa, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. 5. NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cowley Road, Cambridge CB4 0WS, UK. 6. Ordre professionnel des diététistes du Québec, Montréal, Québec, Canada. 7. Department of Medicine & Dentistry, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada. 8. Clinical Nutrition Service, Niagara Health, St. Catharines Ontario L2S 0A9, Canada. 9. Réseau de santé Vitalité Health Network, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada. 10. School of Human Movement and Nutrition Sciences, The University of Queensland & The Prince Charles Hospital, Rode Road, Chermside, QLD 4032, Australia.
Abstract
BACKGROUND: Improving the detection and treatment of malnourished patients in hospital is needed to promote recovery. AIM: To describe the change in rates of detection and triaging of care for malnourished patients in 5 hospitals that were implementing an evidence-based nutrition care algorithm. To demonstrate that following this algorithm leads to increased detection of malnutrition and increased treatment to mitigate this condition. METHODS: Sites worked towards implementing the Integrated Nutrition Pathway for Acute Care (INPAC), including screening (Canadian Nutrition Screening Tool) and triage (Subjective Global Assessment; SGA) to detect and diagnose malnourished patients. Implementation occurred over a 24-month period, including developmental (Period 1), implementation (Periods 2-5), and sustainability (Period 6) phases. Audits (n = 36) of patient health records (n = 5030) were conducted to identify nutrition care practices implemented with a variety of strategies and behaviour change techniques. RESULTS: All sites increased nutrition screening from Period 1, with three achieving the goal of 75% of admitted patients being screened by Period 3, and the remainder achieving a rate of 70% by end of implementation. No sites were conducting SGA at Period 1, and sites reached the goal of a 75% completion rate or referral for those identified to be at nutrition risk, by Period 3 or 4. By Period 2, 100% of patients identified as SGA C (severely malnourished) were receiving a comprehensive nutritional assessment. In Period 1, the nutrition diagnosis and documentation by the dietitian of 'malnutrition' was a modest 0.37%, increasing to over 5% of all audited health records. The overall use of any Advanced Nutrition Care practices increased from 31% during Period 1 to 63% during Period 6. CONCLUSION: The success of this multi-site study demonstrated that implementation of nutrition screening and diagnosis is feasible and leads to appropriate care. INPAC promotes efficiency in nutrition care while minimizing the risk of missing malnourished patients. TRIAL REGISTRATION: Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016.
BACKGROUND: Improving the detection and treatment of malnourished patients in hospital is needed to promote recovery. AIM: To describe the change in rates of detection and triaging of care for malnourished patients in 5 hospitals that were implementing an evidence-based nutrition care algorithm. To demonstrate that following this algorithm leads to increased detection of malnutrition and increased treatment to mitigate this condition. METHODS: Sites worked towards implementing the Integrated Nutrition Pathway for Acute Care (INPAC), including screening (Canadian Nutrition Screening Tool) and triage (Subjective Global Assessment; SGA) to detect and diagnose malnourished patients. Implementation occurred over a 24-month period, including developmental (Period 1), implementation (Periods 2-5), and sustainability (Period 6) phases. Audits (n = 36) of patient health records (n = 5030) were conducted to identify nutrition care practices implemented with a variety of strategies and behaviour change techniques. RESULTS: All sites increased nutrition screening from Period 1, with three achieving the goal of 75% of admitted patients being screened by Period 3, and the remainder achieving a rate of 70% by end of implementation. No sites were conducting SGA at Period 1, and sites reached the goal of a 75% completion rate or referral for those identified to be at nutrition risk, by Period 3 or 4. By Period 2, 100% of patients identified as SGA C (severely malnourished) were receiving a comprehensive nutritional assessment. In Period 1, the nutrition diagnosis and documentation by the dietitian of 'malnutrition' was a modest 0.37%, increasing to over 5% of all audited health records. The overall use of any Advanced Nutrition Care practices increased from 31% during Period 1 to 63% during Period 6. CONCLUSION: The success of this multi-site study demonstrated that implementation of nutrition screening and diagnosis is feasible and leads to appropriate care. INPAC promotes efficiency in nutrition care while minimizing the risk of missing malnourished patients. TRIAL REGISTRATION: Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016.
Authors: Janet E Squires; Danielle Cho-Young; Laura D Aloisio; Robert Bell; Stephen Bornstein; Susan E Brien; Simon Decary; Melissa Demery Varin; Mark Dobrow; Carole A Estabrooks; Ian D Graham; Megan Greenough; Doris Grinspun; Michael Hillmer; Tanya Horsley; Jiale Hu; Alan Katz; Christina Krause; John Lavis; Wendy Levinson; Adrian Levy; Michelina Mancuso; Steve Morgan; Letitia Nadalin-Penno; Andrew Neuner; Tamara Rader; Wilmer J Santos; Gary Teare; Joshua Tepper; Amanda Vandyk; Michael Wilson; Jeremy M Grimshaw Journal: CMAJ Date: 2022-02-28 Impact factor: 16.859